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Lottie's DPD 2 > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What do you need to ask about in HPC?

A 
Age and sex 
Joints - large / small / spine / sacral 
Long / gradual or sudden /acute 
Is pain better or worse on movement?
Is stiffness worse in morning / after rest? 
Swelling?
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2
Q

What PMH/FH Qs are relevant to arthritis?

A

Arthritis
AID - hypothyroidism or T1DM
Inflam conditions - psoriasis, iritis, IBD

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3
Q

What SH Qs do you need to ask for arthritis?

A

Occupation - effect of symptoms on job

Smoking

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4
Q

What do you look for O/E of joints?

A

INSPECTION = Which joints? Swelling / rash / nail changes
PALPATION = temperature, tenderness, swelling - bony/soft?
MOVEMENT = range of movement, pain/crepitus on movement
Contrast active vs passive

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5
Q

Which type of movement mainly tests bones and not tendons?

A

Passive

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6
Q

List types of arthritis

A

Osteoarthritis
Rheumatoid
Crystal
Spondyloarthritis

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7
Q

What % of adults have osteoarthritis?

A

10%

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8
Q

Which joints do osteoarthritis affect?

A

Base & ends of thumbs, DIPJ, PIPJ

Hips, knees

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9
Q

List 3 components of osteoarthritis

A

Cartilage degradation
New bone formation - osteophytes
Inflammation - synovitis / effusion

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10
Q

What is PC of osteoarthritis?

A

Gradual
Pain on weight bearing joints
Stiffness for 30 mins
Swelling

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11
Q

List classic deformities of osteoarthritis

A

Heberdens nodes = DIPJ
Bouchards nodes = PIPJ
Squaring of thumb base
Varus at knee - medial cartilage wearing away

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12
Q

List XR changes of osteoarthritis

A

Loss of joint space
Subchondral sclerosis (thickening)
Cysts
Osteophytes

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13
Q

What is Mx of osteoarthritis ?

A

No disease modifying drugs
Education & physio
Pain relief

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14
Q

Pathophysiology of gout?

A

XS uric acid deposition

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15
Q

Where does uric acid come from?

A

Purine metabolism

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16
Q

Describe the uric acid crystals

A

Needle shaped negatively birefringent crystals

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17
Q

PC of gout

A

1st MTP in toe
Short, acute, VERY painful and stiff and swollen
+/- tophi

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18
Q

Ix for gout?

A

BLOODS: urate, CRP, ESR

XR of area

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19
Q

What will XR of gout show?

A 
Early = nothing 
Late = rat bite erosions at side of bone
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20
Q

Mx of gout?

A

NSAIDs or colchicine (acute)

dietary advice +/- allopurinol (long term)

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21
Q

What enzyme metabolises purine?

A

Xanthine oxidase

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22
Q

What should be avoided in low purine diet?

A

BEER
Fish eg anchovies, mackerels
Game
Spinach, cauliflower, lentils, asparagus

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23
Q

What is a contraindication to allopurinol?

A

Azathioprine

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24
Q

What is pseudo gout?

A

Calcium pyrophosphate deposition

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25
Shape of pseudo gout crystals?
positively birefringent rhomboids
26
To whom & where does pseudo gout occur?
Knees and wrists | Older females
27
What is the hallmark of RA?
Synovial inflammation
28
List polymorphisms that can lead to RA
HLA class 2 eg DR4 and DR1
29
What AB is present in RA?
Anti CCP
30
Is rheumatoid factor IgG or IgM?
IgM
31
PC of RA?
``` Polyarticular small joint stiffness Morning and post-rest stiffness Joint swelling FH of RA or AID Smoking is a risk factor ```
32
Who does RA affect?
40-50y/o females
33
Which joint is involved in RA?
MPJs
34
O/E RA?
Soft swelling | Painful on movement
35
Signs of uncontrolled RA?
``` Swan neck deformities Boutonnieres Z thumb Ulnar deviation at MCPs Wrist subluxation ```
36
Other signs outside of RA hands?
Atlanto-axial subluxation | Synovitis destroys transverse ligament
37
Systemic Sx of RA?
``` Episcleritis / scleritis / keratitis ILD Pericarditis / effusion Vasculitis Rheumatoid Nodules ```
38
XR features of RA?
Joint space narrowing Periarticular osteopenia Errosive damage Joint deformities
39
If RA is suspected, how quickly do they get seen by rheumatology?
3 weeks
40
Ix of RA?
CRP/ESR Anti CCP RF USS / MRI / XR baseline
41
What does RA predispose to?
Osteoporosis
42
Mx of RA?
Analgesia PRN antiinflammatories IM steroids
43
What are the disease modifying drugs for RA?
Methotrexate TNF alpha blocker Jakinibs
44
List 4 types of spondyloarthritides
Axial spondyloarthritis Psoriasis arthritis Reactive arthritis Enteropathic arthritis
45
List common features of spondyloarthritides
HLA B27 Enthesitis Arthritis
46
What is enthesitis?
Inflammation of where soft tissue insert into bone
47
What polymorphism is associated with spondyloarthritides ?
HLA B27
48
What is the hallmark of spondyloarthritides?
Enthesitis
49
List features of spondyloarthritides
Synovitis Large joints Some small joints Dactylitis (swelling of whole digit)
50
What rash do you get on soles of feet in reactive arthritis?
Keratoderma blenorrahgia
51
Axial spondyloarthritides PC?
Male, <25 | Inflammatory back pain insidious onset, pain at night, improves with exercise, worse with rest
52
Test for Axial spondyloarthritides?
Schober's test lumbar forward flexion | Thoracic expansion
53
Imaging results for Axial spondyloarthritides?
Sacroilitis and shiny corner (enthesitis)
54
Posture of Axial spondyloarthritides?
Question mark posture
55
MRI findings of Axial spondyloarthritides?
Calcification of ligaments | Loss of joint space between vertebrae
56
Psoriatic features?
Scaly skin rash on flexures Psoriasis on scalp Nail changes- pitting and onycholisis
57
Reactive arthritis peripheral features?
Keratoderma blenorrhgagia (soles of feet and hands) Conjunctivitis Circinate balanitis
58
What organisms can trigger reactive ?
Chlamydia | Salmonella, shigella, yersinia, campylobacter
59
Who does enterohepatic arthritis affect?
IBD patients
60
Ix for Axial spondyloarthritides?
HLA B27 CRP/ESR Imaging - MRI USS for peripheral joint inflammation
61
Mx of Axial spondyloarthritides?
``` Analgesia NSAIDs Steroids Methotrexate TNF alpha blocker Jakinibs ```
62
Which drugs are disease modifying in Axial spondyloarthritides?
Methotrexate TNF alpha blocker Jackinibs

Lottie's DPD 2 (10 decks)

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